Organization
IOWA SPEECH THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE RAE SUTHERLAND M.A., CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST/OWNER)
(319) 533-2916
Entity
Organization
Contact information
Practice address
118 E MAIN ST, SUITE B, ANAMOSA, IA 52205-1871
(319) 533-2916
(319) 462-0546
Mailing address
PO BOX 425, ANAMOSA, IA 52205-0425
(319) 533-2916
(319) 462-0546
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
001793
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB1873
MEDICARE PTAN
IA
Enumeration date
02/10/2011
Last updated
04/12/2011
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